All About Multiple Sclerosis

More MS news articles for April 2003

The little neurotoxin that could

April 20th, 2003, 9:28 PM
By Elizabeth Weise

It was originally approved for medical use in the USA 14 years ago to treat crossed eyes and uncontrollable blinking. Today, it has been used by more than 2.5 million people in 70 countries to treat a wide variety of conditions.

It can help children with cerebral palsy walk. It can end migraines. Doctors who once could only recommend multiple surgeries are now using it to cure clubfoot in infants. It can greatly diminish the physical tics associated with Tourette's syndrome and has been used to treat the severely obese. And this week, British scientists announced that it might treat the chronic pain of cancer.

Not bad for something normally associated with frivolous self-involvement. Because the drug in question is the botulinum toxin, commonly sold in the USA as Botox.

It may indeed be the friend of aging starlets with its wrinkle-reducing powers. But it also is the deadliest neurotoxin on the planet, able to destroy nerve and muscle function in tiny doses. And it's a biochemical miracle worker that stops nerves from being able to contract muscles for months at a time.

The first doctor to test the botulinum toxin on humans was Alan Scott of the Smith-Kettlewell Eye Research Institute in San Francisco in 1977. He was looking for a treatment for lazy eye, in which one set of eye muscles is hyperactive and crosses the eyes. A decade later, Canadian ophthalmologist Jean Carruthers, who was using the botulinum toxin to treat eye twitches, noticed that her patients looked more relaxed. With her husband, derma- tologist Alastair Carruthers, she published her findings on its use in the treatment of facial wrinkles in 1989, the same year the Food and Drug Administration first approved it for treating crossed and twitching eyes.

A way to stop migraines

Next, dermatologists began to notice that when their now wrinkle-free patients returned for follow-up treatments, about two-thirds of them reported that they'd also stopped having migraines.

"So many of the people we were treating for frown lines came in and said, 'I haven't had to take any migraine medicine for eight weeks, and that's never happened before,' " says Richard Glogau, a professor of dermatology at the University of California-San Francisco.

Today, Glogau and colleagues treat increasing numbers of migraine patients. Treatments are needed every three to four months.

Controlling cerebral palsy

Botulinum toxin also has been a wonder drug for people with cerebral palsy, a movement disorder caused by inappropriate muscle activity. Most sufferers have muscles that are constantly contracting. In the early 1990s, neurologists realized that if muscles relaxed, patients might regain some control.

"By relieving too much muscle activity in certain muscle groups, other muscle groups are better able to function, to move the limb as they normally would," says Maj. Marc DiFazio, a pediatric neurologist at Walter Reed Medical Center in Washington, D.C.

Botox enabled one of DiFazio's patients to walk. "He's 14, and he's never walked," says DiFazio. "So we relaxed the hamstrings, the muscles at the back of the thigh, and we added aggressive stretching and gait training. He was able to go from standing to walking."

Botulinum toxin treatment has been a boon to patients because it is so muscle-specific, DiFazio says.. "The alternative treatments for spasticity are surgically releasing muscle groups or nerves, or oral medications to globally release tone throughout your body." But, he adds, the drugs are very strong and leave patients flexible but "pretty loopy."

Easing Tourette's syndrome

Botox also has been used to help people with Tourette's syndrome, who are beset by tics and spasms. "Somebody with Tourette's gets a funny tingling, burning sensation in their neck, and the only way they can relieve that is to shrug their shoulder or bend their head backwards," he says.

Researchers believe it is that initial tingling sensation that sets the patients off. By giving them Botox, researchers were able to help the patient's nervous system short-circuit the initial sensation. The tics decreased markedly in some patients.

Correcting clubfoot without surgery

In Canada, pediatric orthopedic surgeon Christine Alvarez read about new uses for Botox and immediately thought of the babies she routinely operated on for clubfoot at the Children's and Women's Hospital of British Columbia.

Clubfoot is a congenital disorder in which the foot is turned in and upwards. Untreated, the person ends up walking on the top of the foot. One in 1,000 babies are born with the deformity. Traditional therapy often included surgery on the baby to release abnormal joints, lengthen tight tendons and move bones into normal position. But cutting a tendon results in a 30% loss of strength in the muscle.

Alvarez realized in 2000 that botulinum toxin might accomplish the same thing without surgery. Injecting the calf muscles that attach to the Achilles tendon "allows the tendon to relax, and the foot can go into the normal position," she says. "We use the traditional boots and bars till they're 4 months of age" to reposition the foot "and then they're put in a proper pair of running shoes, and only the boots at night."

Alvarez has now performed the procedure on 65 children, and only one has needed surgery.

Taming a spastic bladder

Botox was life-changing for Deanna Broujos, 37, of Pittsburgh, diagnosed with multiple sclerosis four years ago. Her MS was causing a condition called spastic bladder: Her bladder would suddenly go into spasm and she'd need a bathroom immediately.

Her urologist, Michael Chancellor of the University of Pittsburgh School of Medicine, began experimenting with Botox in 1998 because he was frustrated with the drug options, which had side effects that included dry mouth, blurred vision and constipation.

Chancellor inserts a tiny fiber-optic scope into the bladder through the urethra. At the end of the scope is a tiny needle that Chancellor uses to inject 20 to 30 pinpoints of Botox in the walls of the bladder. The procedure takes about 10 minutes and usually lasts six months. He has treated about 100 patients.

Chancellor suggested the treatment to Broujos in December, and she was eager to try it. It gave her "freedom, peace and independence," she says. "I'm able to sleep through the night. It's a huge difference."

Weight loss for the obese

Researchers in Germany and Italy are experimenting with botulinum toxin as a non-surgical alternative to stomach-diminishing surgery for obesity.

Jens Rollnik, a neurologist at the University of Hannover Medical School in Germany, reported the first such treatment in the Annals of Internal Medicine. The patient was a 33-year-old who was 5-foot-8 and weighed 221 pounds. Rollnik injected botulinum toxin into the patient's gastric wall.

Afterward, the patient reported feeling full after eating only small amounts of food. His food intake decreased 67% in the first month, 43% in the second month and 32% in the fourth. He lost 20 pounds. The effects lasted about five months. Rollnik says botulinum toxin has fewer risks and side effects than surgery such as gastric banding.

Curing chronic pain

British scientists are working on using Botox as a cure for chronic pain. New Scientist reported Saturday that Keith Foster of the Centre for Applied Microbiology and Research in Great Britain is using the botulinum toxin in conjunction with a protein from the Mediterranean coral tree to develop a drug that paralyzes the nerves that transmit pain signals.

Tests on mice have shown the new drug works as well as morphine but lasts up to nine days. At a Society for General Microbiology meeting in Scotland, Foster said his group plans to begin tests on people with cancer and patients recovering from surgery.

Never let 'em see you sweat

Botox is being used to treat hyperhydrosis, or excessive sweating of the palms and hands, by deadening the nerves that connect to the sweat glands. Up to 8 million Americans have this condition. They sweat so much that they can't shake hands and at times can't work with their hands because they become too slippery.

San Francisco's Glogau believes botulinum toxin will be increasingly used to end underarm sweating. "I think you'll see the day when it will be used as a personal grooming agent."

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